Salty broth for salicylate poisoning?
Physicians and patients are given the difficult task of navigating through a rising tide of pills, as more medications are released onto the market every year. The Compendium of Pharmaceuticals and Specialties has been a useful source of information for physicians and their patients. It is often used as a reference for dosages, indications and contraindications. But should it be used as a reference to guide physicians in the management of drug overdoses? Jeffrey Brubacher and colleagues, from the British Columbia Drug and Poison Information Centre, separately reviewed the adequacy of the advice given in the 2001 Compendium of Pharmaceuticals and Specialties for 10 classes of medications for which an overdose is frequently fatal and graded the quality of the recommendations. Of 119 monographs, half contained dangerous or misleading advice.
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Figure. Photo by: Corbis/Magma
See page 992
Understanding atrial fibrillation
Atrial fibrillation is the most common arrhythmia. It remains difficult to manage and is associated with high morbidity. One of the keys to improving our control over it is to understand its mechanisms better. Paul Khairy and Stanley Nattel describe recent information on the physiologic aspects of atrial fibrillation and use this information to explain the successes and failures of our current treatments. They also discuss the latest clinical practice guidelines and provide preliminary results from the AFFIRM trial.
See page 1012
Adults with genetic disorders
As our genome continues to unravel, scientists and clinicians are appreciating the important role of DNA in the development of many common diseases. Although most adult diseases are multifactorial, meaning that genetic factors combine with environmental ones to produce a phenotype, there are specific genetic conditions that manifest themselves in adulthood. This article, the third in a series, lists reasons why one might suspect a genetic disorder in an adult and describes an approach to diagnosis, necessary investigations and potential treatments. In a related article, Genetics 101 describes the technique that has given science its success with genetic sequencing. The polymerase chain reaction amplifies segments of DNA, sometimes a billion-fold, and has become integral to testing for parasitic, viral or bacterial DNA and diagnosing genetic diseases.
What is the initial treatment for mild asthma? Not combination therapy…
Combination therapy, meaning long-acting β2-agonists and inhaled corticosteroids, is increasingly being used to treat mild asthma. It offers convenience and the potential for improving compliance, but it is also much more expensive than therapy with inhaled corticosteroids alone. The Asthma Committee of the Canadian Thoracic Society discusses the evidence for combination therapy and reiterates, despite advertisements to the contrary, that it should not be used as initial standard treatment.
See page 1008
Exercise programs to reduce the risk of falls in women with osteoporosis
The benefits of exercise have been extolled for nearly every disease. Physiologically, it has been accepted that exercise maintains bone mass, but the influence on the morbidity of osteoporosis may be more profound. Evidence is increasing that exercise programs can reduce falls in older people by modifying predisposing factors. Nick Carter and colleagues conducted a randomized controlled trial in Vancouver to test the hypothesis that a 20-week exercise program in a community setting would improve objective measures of balance and strength, both important determinants of the risk of falling. In a related commentary, John Campbell discusses the challenges of designing programs to reduce the risk of falls.
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Figure.